Ch.43 Pain Management Flashcards
How does physical pain and psychogenic pain differ?
Physical pain is caused by a physical experience such as joint pain due to arthritis or surgical pain incisional pain
Psychogenic pain is caused by psycological factors mental or emotional factors that can increase or decrease the perspective of pain an individual is undergoing for example patient may say they have a headache,muscle pain and stomach pain but is not related to their diagnosis
What is pain?
Pain is a subjective and emotional experience that An individual goes through that may cause any alterations and physical ,emotional ,cognitive components and is associated with any potential tissue damage or any damage in that aspect
No two individuals may have the same pain
What are the classifications of pain
Source:
Nociceptive
Neuropathic
psychogenic
referred
Duration:
acute
chronic
By what four physiological processes must occur for pain sensation
transduction
Transmission
perception
modulation
Nociceptive pain: what occurs during phase 1
transduction
during transduction thermal, chemical, mechanical stimuli is converted into electrical energy
For example I touch a hot iron with my finger that thermal stimuli is converted to an electrical energy that is sent through the sensory afferent nerve fibers, action potential
Transmission phase 2
****Box 43-1 Neuroregulators********
Cellular damage caused by stimuli results in the release of which neurotransmitters ?
(Excitatory)
Prostaglandin - sends pain message and causes inflammatory response
Breakdown of phospholipids
Increases sensitivity to pain
Bradykinin
Released from plasma from injured tissue
Increases pain stimuli
Binds to cell that cause chain reaction
Substance P
Released at the dorsal horn
Needed to transmit pain impulses up through the spinothalmic tract nerves to reach the higher brain centers
Causes vasodilation and edema
Histamine
Produce by mast cells causing capillary dilation and permeability
Transmission phase 2
How is pain stimuli conducted ?
By two types of peripheral nerve fibers
A-Delta fibers :
Fast
Myelinated
Sharp , localized, and distinct sensations
The first initial reaction towards a pain stimuli
-ex when stepping on a nail it is direct and sharp
C-Fibers:
Small
Slow
Unmyelinated
Poorly localized - it’s widespread
Burning sensation
Persistent
Ex after stepping on nail, you feel your foot throbbing and the pain feels like it has spread through your foot
Perception phase 3
Perception
Recognizing the pain
Interpreting the meaning of pain influenced by your past experiences, knowledge about it , and cultural views (certain cultures perceive pin to be kept to a minimum and others view it as to be open about it and express what they feel, crying, yelling, moaning
Fourth phase
Modulation
Inhibiting the impulse of pain -analgesic feeling
Becoming numb
**Box 43-1 neuromodulators****
Release of neuromodulators during the modulation phase
Activated by stress and pain
Cause analgesia when attach to opiate receptors
Located in brain ,spinal cord, and gi tract
Serotonin
Aids in stopping pain transmission
Released from the brainstem and dorsal horn
Norepinephrine
GABA
Gate control theory of pain
The suggesting the theory that gate mechanisms is what control the pain an individual experiences
Open gate lets electrical impulses from the spinal cord to the higher brain centers thus allowing the individual experience the pain
Closed gate ,which can be accomplished by non pharmocological interventions-(massage , warm compresses )doesn’t allow those impulse reach the brain centers in which the individual can withhold more pain–> ( pain threshold:endorphins)exercise
Table 43-1 Physiological reactions to pain**
The body responses in many ways towards pain:
SYMPATHETIC
Dilation of :
bronchial tubes - oxygen intake
Pupils - better vision
Increased: respiration Heart rate -increased oxygen transport Blood glucose levels - higher energy Muscle tension- prepares muscle for action
Peripheral vasoconstriction
Pallor
Elevated BP
(Blood shifts from peripheral to brain and skeletal muscles)
Sweating-body temp control
Deceased GI motility
PARASYMPATHETIC
Pallor
Decreased heart rate ,BP
Rapid , irregular breathing
*******table 43-2
Classification of pain by inferred pathology***
Nociceptive : A.somatic pain Bone Joint Muscle Skin Throbbing ,aching quality , localized
B.visceral pain
Tumor causing ache localized pain
Obstruction of hollow organ -cramping localized pain
NEUROPATHIC PAIN A. Centrally generated pain -deafferentation pain Injury to cns Ex phantom pain -Sympathetically maintained pain Associated with impaired ANS
B. Peripherally generated pain -Painful polynueropathies: Pain along peripheral nerves -painful mononeuropathies: Known Nerve injury and pain along the nerve
**Box 43-3 focus on older adults**
–Eat poorly , decreased serum albumin levels
At risk for drug toxicities
–Decline of live and kidney functions which impairs excretion process of medication causing intensified peaks and longer in duration of effects
–age related skin thinking affects the absorptions rate of topical medications
**BOX 43-5 How can The nurse identify pain symptoms*******
Using the PQRST mnemonic
P is for palliative or provocative makes you feel pain worse,? What makes it better?
Q is for Quality how do you describe your pain our
R is for region /radiation where does it hurt the spread to other places S is for severity of pain scale 10 to 10 how bad is your pain
T is for timing is it Constant or intermittent
***BOX 43-6 PAIN ASSESSMENT APPROACH **
A is for ask about pain regularly assess pain
B is belief the patient and family when they report pain
C is for choose the pain control options that is best for the patient
D is for delivery of the interventions in a timely logical fashion
E is for empowerment patients and family to be able to control the situation to the greatest extent
****TABLE 43-5 CLASSIFICATION OF PAIN BY LOCATION ***
how is paying classified by where it is located
Superficial or cutaneous
pain results from the stimulation of the skin
-short , sharp and localized
Deeper visceral pain results from the stimulation of internal organs -sharp dull unique radiates longer duration
Referred
pain is in other directions then organs because of no pain receptors
for example IM causes pain to jaw , left arm and left shoulder
Pain was referred to other location
Radiating
the pain extends from the initial side to other body part feels as it travels along body part
can be constant or intermittent
**Box 43-9 PAIN BEHAVIORS*******
How will the patient show their pain ?
Vocalize : moaning crying gasping Grunting
Facial exp: Grimace Clenched teeth Face tightening Lip biting
Body movement: Restlessness immobilized Muscle tension Grabbing body Pacing
Social ness: Avoids people Focuses on other things to keep mind off pain Doesn't stay focused Lower attention span
**BOX 43-12 patients environment****
How can the nurse use patients environment to help with pain stimuli?
The nurse can fix the linen on the bed positioning the patient loose bandages change wet dressing align the patient check temperature of applications Lift patient when repositioning up and down the bed do not positioning patient on the bedpan correctly cleaned patient when soilage is observed prevent injury from Foley catheter Keep patients clean and dry prevent constipation with interventions
**BOX 43-13 nursing principles for analgesics*
Remember to ask or no patient
Know if patient is at risk for G.I. bleeding or renal insufficiency
sleep for apnea-opioids
Ask medication was effective
Used combinations for mild to moderate pain
you can give opiates with non-opioids
older adults avoid the combination
morphine fentanyl patches or hydromorphone is for long-term management
avoid intramuscular analgesics especially in older adults
Know accurate dosage
4 grams is considered the maximum 24 hour dosage for acetaminophen and ASA ;for ibuprofen 3200mg
Around the clock schedule is the best for the patient
administer pain med as soonest patient states
Avoid abruptly stopping and know the duration of action for the drug
